Lessons From the Coronavirus Disease Experience: Research Participant and Staff Satisfaction With Remote Cognitive Evaluations

OBJECTIVE

In New York City in 2020 the pandemic shut down in-person research. Icahn School of Medicine's Alzheimer's Disease Research Center transitioned longitudinal evaluations from in-person to telephone to enhance equity of access. We assessed diverse research participants' and clinical research coordinators' (CRC) satisfaction with remote evaluation and examined sociodemographic, cognitive, and behavioral factors that might impact satisfaction.

METHODS

Data collected: 241 participants with Clinical Dementia Rating (CDR) = 0/0.5 (3/2020 to 6/2021). A Telehealth Satisfaction Questionnaire for CRCs and participants was administered at the end of remote evaluations. We compared Telehealth Satisfaction Questionnaire items by CDR and Geriatric Depression Scale.

RESULTS

Participants' mean age was 78.4, 61.4% were females, 16.2% were Hispanic, 17.1% Asian, 15.8% were non-Hispanic black, and 72.6% CDR = 0. Participant satisfaction was high [14.1 ± 1.4 (out of 15)] but was lower among those with depression. CRC satisfaction was high [16.9 ± 1.8 (out of 18)] but was lower concerning the ability to explain the test battery and interact with participants with CDR = 0.5.

CONCLUSION

Telephone research assessments provide flexibility in a hybrid model. They offer equitable access to research participation for those who do not use computer technology and may promote the retention of diverse elderly research participants.

Socio‐psychological impact of COVID‐19 on a diverse cohort of older adult research participants in New York

Background

During the spring of 2020, New York was overwhelmed by COVID‐19 and older adults as well as ethnic minorities were disproportionately affected. The Alzheimer’s Disease Research Center (ADRC) located in East Harlem in New York City, serves a predominantly low income, Latinx community. It was imperative to gauge the impact of COVID‐19 on our diverse group of older adult research participants.

Method

Participants enrolled in the ADRC with a Clinical Dementia Rating Scale of 0 (75%) or .5 (24%) completed evaluations between May and December 2020 for the National Alzheimer’s Cooperative Center Uniform Data Set (NACC UDS) and were administered a 33‐item COVID‐19 questionnaire over the telephone that was modified from the questionnaire provided by NACC. The 15–20 minute survey asked questions about social, psychological, and emotional experiences with COVID‐19, including whether they had lost a loved one to COVID, as well as items targeting the psychological sequelae of the pandemic (depression, isolation, a sense of loss of control, for example).

Result

198 participants completed the questionnaire. Of these, 55% were non‐Hispanic White, 15% were non‐Hispanic Black, 14% were Hispanic, and 16% were Asian. The overall sample’s mean age was 76.4±7.5, mean education 15.80±3.1years, and 62.6% were male. Survey results indicated that 89% felt the pandemic had been disruptive to their lives, and 30% had lost a loved one to COVID. Sixty‐three percent of participants reported being in touch remotely with friends or family nearly every day, and 24% 2‐3x/week. Thirty two percent reported feeling they could not control important things in their life and feeling anxious (46%), bored (41%), and lonely (30%). Twenty seven percent reported feeling depressed and 23% experienced sleep problems.

Conclusion

In this diverse sample of community dwelling older adults, most were able to remain in close contact with family and friends, and many reported the pandemic as disruptive. However, fewer reported experiencing a loss of control as well as psychological or emotional distress (i.e., depression) which may reflect adaptive mechanisms worthy of further study.

Smartphone ownership and usage in Chinese- and English-speaking older adults

BACKGROUND

Data collection by smartphone is becoming more widespread in healthcare research. Previous studies reported racial/ethnical differences in the use of digital health technology. However, cross-language group comparison (Chinese- and English-speaking older adults) were not performed in these studies. This project will expand to smartphone technology use in diverse older populations with a focus on Chinese American older adults who are monolingual Chinese-speakers.

METHOD

The Alzheimer's Disease Research Center (ADRC) at Icahn School of Medicine at Mount Sinai (ISMMS) evaluates diverse older populations using National Alzheimer's Coordinating Center's Uniform Data Set (NACC UDS). The UDS has different language versions, including English and Chinese. The evaluation includes a medical examination, cognitive assessments, and a research blood draw. Smartphone ownership and usage were captured using a local questionnaire developed by our ADRC. The questionnaire, available in English and Chinese, was administered by our ADRC coordinators during the COVID-19 pandemic. Multivariate analysis of variance (MANOVA) was used to examine differences in technology ownership and usages between the two language groups, while controlling for age, gender, education, and cognitive status (measured by Clinical Dementia Rating).

RESULT

33 Chinese- and 117 English-speaking older adults who received a diagnosis of normal cognition or mild cognitive impairment at consensus were included in the data analysis. Results reveal a high prevalence of smartphone ownership in our Chinese- (100%) and English-speaking older participants (86.3%). Participants in both language groups use mobile technology for a wide range of purposes, such as getting news and other information (Chinese=90.9%; English=87.2%), sending/receiving text (Chinese=97.0%; English=96.6%), watching videos/TV shows (Chinese=78.8%; English=69.2%), and taking classes (Chinese=57.5%; English=57.3%). However, Chinese-speaking older adults were less likely than English-speaking older adults to use mobile technology to post their own reviews or comments online (Chinese=9.1%; English=39.3%, p=0.001), download or purchase an app (Chinese=21.2%; English=70.9%, p<0.001), track health/ fitness via apps/website (Chinese=12.1%; English=47.9%, p<0.001) and manage/receive medical care (Chinese=15.2%; English=67.5%, p<0.001).

CONCLUSION

Our findings highlight potential barriers to smartphone usage in Chinese American older adults with limited English proficiency. The results have implications for how smartphone technology can be used in clinical practice and aging research.

Boston Naming Test: Lose the Noose

OBJECTIVE

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation.

METHOD

Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA.

RESULTS

Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance.

CONCLUSIONS

Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Many Labs 5: Testing Pre-Data-Collection Peer Review as an Intervention to Increase Replicability

Replication studies in psychological science sometimes fail to reproduce prior findings. If these studies use methods that are unfaithful to the original study or ineffective in eliciting the phenomenon of interest, then a failure to replicate may be a failure of the protocol rather than a challenge to the original finding. Formal pre-data-collection peer review by experts may address shortcomings and increase replicability rates. We selected 10 replication studies from the Reproducibility Project: Psychology (RP:P; Open Science Collaboration, 2015) for which the original authors had expressed concerns about the replication designs before data collection; only one of these studies had yielded a statistically significant effect ( p < .05). Commenters suggested that lack of adherence to expert review and low-powered tests were the reasons that most of these RP:P studies failed to replicate the original effects. We revised the replication protocols and received formal peer review prior to conducting new replication studies. We administered the RP:P and revised protocols in multiple laboratories (median number of laboratories per original study = 6.5, range = 3–9; median total sample = 1,279.5, range = 276–3,512) for high-powered tests of each original finding with both protocols. Overall, following the preregistered analysis plan, we found that the revised protocols produced effect sizes similar to those of the RP:P protocols (Δ r = .002 or .014, depending on analytic approach). The median effect size for the revised protocols ( r = .05) was similar to that of the RP:P protocols ( r = .04) and the original RP:P replications ( r = .11), and smaller than that of the original studies ( r = .37). Analysis of the cumulative evidence across the original studies and the corresponding three replication attempts provided very precise estimates of the 10 tested effects and indicated that their effect sizes (median r = .07, range = .00–.15) were 78% smaller, on average, than the original effect sizes (median r = .37, range = .19–.50).

Many Labs 5: Registered Replication of Albarracín et al. (2008), Experiment 5

In Experiment 5 of Albarracín et al. (2008), participants primed with words associated with action performed better on a subsequent cognitive task than did participants primed with words associated with inaction. A direct replication attempt by Frank, Kim, and Lee (2016) as part of the Reproducibility Project: Psychology (RP:P) failed to find evidence for this effect. In this article, we discuss several potential explanations for these discrepant findings: the source of participants (Amazon’s Mechanical Turk vs. traditional undergraduate-student pool), the setting of participation (online vs. in lab), and the possible moderating role of affect. We tested Albarracín et al.’s original hypothesis in two new samples: For the first sample, we followed the protocol developed by Frank et al. and recruited participants via Amazon’s Mechanical Turk ( n = 580). For the second sample, we used a revised protocol incorporating feedback from the original authors and recruited participants from eight universities ( n = 884). We did not detect moderation by protocol; patterns in the revised protocol resembled those in our implementation of the RP:P protocol, but the estimate of the focal effect size was smaller than that found originally by Albarracín et al. and larger than that found in Frank et al.’s replication attempt. We discuss these findings and possible explanations.